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ABO Incompatible Transplantation

Chronic Kidney Disease has high incidence in terms of prevalence, and to survive, patients affected require dialysis 3 times a week. Even though dialysis is considered a life saving option, it is not capable of replacing lost kidney function completely and is also a costly procedure.

As life expectancy on dialysis exceeds not more than 6 years, kidney transplantation is the best and effective treatment for chronic kidney failure.

Blood group compatibility was an essential factor for a successful kidney transplant in the past, but now, with a new technique called "Immunoadsorption", ABO incompatible (non-matching blood group) transplantations are being done regularly in countries like Sweden, Germany, US and Japan.

Kamineni is the first and the only medical enterprise in India to offer this highly advanced medical procedure, with 6 successful cases of ABO incompatible transplantations already to our credit.

Kamineni Hospital's transplant team successfully performed the first ever ABO incompatible Kidney Transplantation in India , using the immunoadsorption technique, on a Pune based patient Mr.Deepak on 19th July'2012. They successfully transplanted the kidney of an A + donor (Deepak's father) to an O+ patient (Mr. Deepak) and thus surmounted a huge barrier to kidney transplantation. Since then several such transplantations are successfully performed and now is a routine procedure at Kamineni.

Usual method of removal of existing antibodies has been plasmapheresis. Plasmapheresis means removing the patient's plasma (which contain antibodies). A human adult may have a total blood volume of about 5 liters, of which 2 liters are red blood cells, white blood cells and platelets. The remaining 3 liters are plasma which contains all protein, antibodies and clotting factors. Plasmapheresis is crude and removes all antibodies, both good and bad. We need these good antibodies to protect us from infection. Thus plasmapheresis is associated with high risk of infection. In a transplant patient whose immunity has been lowered to prevent rejection, infection is a major problem.

ABO incompatible transplantation employs a new technique called Immunoadsorption which has a dialyzer column designed to 'catch' only the relevant antibodies (like anti-A group or anti-B group). Anti-A or anti-B group antibodies constitute only 1-2% of the total antibodies in plasma. However with plasmapheresis, 98% of all antibodies are lost in the process of reducing these blood group antibodies. The Immunoadsorption technique removes only the anti-A or anti-B antibodies, thus sparing the good antibodies.

An ABO incompatible transplantation is the best option for a patient who has no compatible donors in the family and the cadaver waiting list is long.

An ABO incompatible transplant costs around twice the cost of a related donor transplant, depending on the recipient's level of antibodies, and a Cadaver transplant costs about 20% more than a related donor transplant. The total cost while waiting (even for as less as 2 years) on the cadaver list and undergoing dialysis can very likely surpass the cost of an ABO incompatible transplantation. Considering this, an ABO incompatible transplant becomes the best choice for the patients who have no compatible donors available in the family.

Kidney Transplant

Chronic Kidney Disease stage 5 (or irreversible kidney failure requiring dialysis) is a life-threatening problem. The options before a patient are life-long dialysis (hemodialysis or peritoneal dialysis). While dialysis is a life saving option, it entails undergoing hemodialysis three times a week for 4 hours each time. Even with the best dialysis programs the patient's creatinine stays at around 5 – 10mg/dl, which means the patient is never free of toxins. Dialysis is thus capable of replacing lost kidney function by only about 25%. This means there is continuing damage to the vital organs and the blood vessels. On dialysis 50% of patients survive 3 years and hardly 10% survive 6 years. Added to this, the high chance of HCV+ infection, which is not curable, and the loss of a job (patient comes to hospital three times a week!), dialysis paints a dismal picture.

The definitive treatment for chronic kidney failure is Kidney Transplantation. Transplantation treats and normalizes all the biochemical, hemodynamic and metabolic abnormalities of kidney failure. A transplanted individual's creatinine becomes normal (around 1mg/dl) and replaces lost kidney function by 80 – 100%. Transplantation bestows full functionality to the patient, who can now work, play and even procreate. After 10 years of transplantation, more than 85% of patients are alive and well. Thus transplantation is the best option for chronic kidney failure. (See the survival graph of dialysis and transplantation)

The donor kidney is usually placed in the groin of the patient and connections are made between the graft and patient's arteries, veins and the ureter is connected to the bladder. The diseased kidneys are not removed in the majority and so the patient now will have 3 kidneys though only one is functional. For a transplant to succeed, two factors are desirable, although they were earlier thought to be absolutely essential. Blood group compatibility between recipient and donor was (for compatible blood groups click here) hitherto considered a must, but is now not a barrier anymore. Likewise, the recipient must not exhibit any antibodies against the donor tissue, termed a positive cross-match.

Even though this is not a contraindication anymore, it definitely carries more risk.

Kidney transplants are of two types. Live (from 1st or 2nd degree relatives) or cadaver (brain-dead donors). Donation from unrelated or commercial donation is not acceptable and is illegal. You cannot buy a kidney. 1st degree relatives are parents, siblings, children and spouse. 2nd degree relatives are uncle, aunts, cousins, in-laws etc where the relationship can be proven by tissue-matching, DNA finger-printing or other means.

Transplantation of a organ from a different individual incites immunological attack from the recipient, which is termed as rejection. Transplantation is possible only because of medications called Immunosuppressants. These medications work by reducing the immunological resistance of the recipient and prevent rejection. These medicines are to be taken life-long. The type of immunosuppression depends on the matching between recipient and donor.

Kidney transplantation involves the donation of a single kidney from a donor. The donor is a medically normal individual, is expected to live a fully normal life after donation and will have no problems. Donors have to be aged above 18 years and preferably below 60 years and should have no medical disorders that can affect the remaining normal functioning kidney later on. So those with diabetes, kidney stones, cardiac disorders, cancers are not accepted as donors. Donors are allowed to donate only after a thorough counseling and medical check-up including kidney function tests. After donation, the donor's kidney function does not decrease and remains the same as prior to donation due to the immense reserve capacity of the kidneys. After donation the donor can continue to work, play and live as before.

Transplantation is a modern medical miracle, which is saving countless number of lives and bestows a great quality of life. For patients with Chronic Kidney Disease stage 5 the first option is to get a transplant. Those who cannot undergo a transplant are condemned to stay on dialysis. The question is not whether transplantation will succeed. Transplants have a success rate 95 – 98% in the modern era. It is dialysis which has a high rate of failure from which there is no return.

Appointments at Kamineni Hospitals

Kamineni Hospital provided appointments to hundreds of people a everyday, we prioritized appointments on the basis of medical needs of each patient.